Review of Outcomes in Pediatric Patients Undergoing Anterior Cruciate Ligament Repairs With Regional Nerve Blocks

Micalizzi, Rosella; Williams, Lee Ann; Pignataro, Shelly; Sethna, Navil F.; Zurakowski, David

doi:10.1016/j.pedn.2014.07.002

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…Although postoperative analgesia use aside from opioids was not analyzed in this study, surgeons and patients must be cautious of the associated prolonged motor paralysis and muscle weakness associated with sciatic and femoral nerve blocks. 11,12 Micalizzi et al 13 speculated that the lack of studies analyzing pediatric pain management following ACL surgery is secondary to physicians treating pediatric patients using the same standard of care used for adult patients and the challenges in performing research in pediatric patients due to variations in growth rates and size affecting study populations and pharmacokinetics.…”

Section: Introductionmentioning

confidence: 99%

“… 11 , 12 Micalizzi et al. 13 speculated that the lack of studies analyzing pediatric pain management following ACL surgery is secondary to physicians treating pediatric patients using the same standard of care used for adult patients and the challenges in performing research in pediatric patients due to variations in growth rates and size affecting study populations and pharmacokinetics.…”

Section: Introductionmentioning

confidence: 99%

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Overprescribing and Undereducating: a Survey of Pre- and Postoperative Pain Protocols for Pediatric Anterior Cruciate Ligament Surgery

Perry¹,

McCormick²,

Knapik³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To establish a better understanding of the variations in pain management protocols and prescribing patterns for pediatric patients undergoing anterior cruciate ligament (ACL) reconstruction or repair. Methods: A 20-question multiple-choice survey was distributed to 3 professional orthopaedic societies to assess the pre-emptive and postoperative pain management prescribing patterns for pediatric patients undergoing ACL reconstruction or repair. Clinical agreement (defined as agreement between >80% of participants) and general agreement (defined as agreement between >60% of participants) were calculated based on responses as previously reported. Results: Clinical agreement was observed among the 68 respondents in use of a single shot nerve block before induction of anesthesia versus continuous use when a peripheral nerve block was used, "always" counseling patients on postoperative pain control, the prescribing of opioids postoperatively, and a lack of change in postoperative protocol when concomitant meniscal repair or meniscectomy was performed. General agreement was observed in the use of a peripheral nerve block, some pre-emptive analgesia practices, and the lack of counseling patients with regard to disposal of unused opioid pain medication postoperatively. Opioids were prescribed by 88% of participants postoperatively, with 48% prescribing 11 to 19 pills and 15% prescribing 20 pills. Conclusions: While pain management practices before and following ACL reconstruction and repair in the pediatric population remain varied, opioids are frequently prescribed postoperatively with many providers neglecting to provide instruction on excess opioid disposal. Clinical Relevance: ACL reconstruction and repair is becoming increasingly common in the pediatric population. Clinical guidelines that establish pre-emptive and postoperative pain-control protocols should be considered to determine safe and optimal pain control throughout the duration of care while minimizing opioid prescribing and consumption.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Overprescribing and Undereducating: a Survey of Pre- and Postoperative Pain Protocols for Pediatric Anterior Cruciate Ligament Surgery

Perry¹,

McCormick²,

Knapik³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…It has been suggested that the use of regional techniques, including peripheral nerve blocks, may be associated with more effective pain control and improved early recovery [17]. In pediatric patients undergoing ACL repair, benefits attributed to the use of peripheral nerve blocks include a reduction in opioid consumption, decreased post-operative pain scores, decreased hospital length of stay, and a reduction in post-operative admission rates [9, 13]. Therefore, experts recommend RA techniques to be used as part of a multimodal regimen [17].…”

Section: Introductionmentioning

confidence: 99%

The Utilization of Regional Anesthesia Among Pediatric Patients: A Retrospective Study

et al. 2020

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Background The use of regional anesthesia (RA) in pediatric patients remains understudied, although evidence suggests benefits over general anesthesia. Questions/Purposes We sought to identify factors associated with RA use in patients under the age of 21 years undergoing ambulatory orthopedic surgery. Methods Patients under the age of 21 who underwent anterior cruciate ligament (ACL) repair or reconstruction, knee arthroscopy (KA), or shoulder arthroscopy (SA) were identified from the NY Statewide Planning and Research Cooperative System (SPARCS) database (2005–2015). Frequencies of RA use (defined by femoral nerve block, spinal, epidural, caudal, or brachial plexus anesthesia) were calculated. Multivariable regression analysis identified patient- and healthcare system–related factors associated with the use of RA. Odds ratios (OR) and 95% confidence intervals (CI) were reported. Results We identified 87,273 patients who underwent the procedures of interest (ACL n = 28,226; SA n = 18,155; KA n = 40,892). In our primary analysis, 14.4% (n = 1404) had RA as their primary anesthetic; this percentage increased for patients who had ACL or KA. When adjusting for covariates, Hispanic ethnicity (OR 0.78; CI 0.65–0.94) and Medicaid insurance (OR 0.75; CI 0.65–0.87) were associated with decreased odds for the provision of RA. Further, we identified increasing age (OR 1.10; CI 1.08–1.11), ACL versus SA (OR 1.91; CI 1.74–2.10), and sports injuries (OR 1.20; CI 1.10–1.31) as factors associated with increased odds of RA use. Conclusion In this analysis, RA was used in a minority of patients under the age of 21 undergoing ambulatory orthopedic surgery. Older age was associated with increased use while Hispanic ethnicity and lower socioeconomic status were associated with lower use.

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“…Femoral nerve block (FNB) and adductor canal block (ACB) are the 2 most frequently used perioperative analgesics to reduce the intake of opioids postoperatively. { While a reduction in postoperative pain and analgesic medication is beneficial, recent studies 1,5,21,22,25 have suggested that perioperative nerve blocks may delay recovery of quadriceps muscle strength, thus delaying return to sport. Determining the effects of these perioperative analgesics on the postoperative quadriceps strength of adolescents will reveal if an analgesic block is most appropriate to optimize recovery after ACL reconstruction and return to sport.…”

mentioning

confidence: 99%

“…However, at 6 months postoperatively, there remains conflicting evidence regarding whether perioperative FNB is associated with a decrease in isokinetic knee extension strength. 21,22,25,31 Differences in surgical techniques, anesthesia protocols, and rehabilitation protocols may have factored into these differing results. Early mobilization has been associated with improved outcomes after ACL reconstruction, which is affected by quadriceps strength and appropriate analgesic control.…”

mentioning

confidence: 99%

Quadriceps and Hamstring Strength in Adolescents 6 Months After ACL Reconstruction With Femoral Nerve Block, Adductor Canal Block, or No Nerve Block

Frazer

Chaussé

Held

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Femoral nerve block (FNB) and adductor canal block (ACB) have been used increasingly for pain control during anterior cruciate ligament (ACL) reconstruction in adolescent patients. However, recent evidence suggests that the use of FNB may affect quadriceps strength recovery 6 months after surgery. Purpose/Hypothesis: To compare postoperative isokinetic strength in adolescents who received FNB, ACB, or no block for perioperative analgesia during ACL reconstruction. We anticipated lower postoperative quadriceps and hamstring isokinetic deficits in adolescents who received FNB as compared with ACB. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were included in the study if they had undergone hamstring tendon autograft ACL reconstruction by a single surgeon from July 2008 to January 2018 and if they underwent isokinetic muscle testing at 4 to 8 months postoperatively. The participants were divided into 3 groups (no block, FNB, and ACB), and we compared the deficit in percentages between the affected and unaffected limbs as calculated from the isokinetic quadriceps and hamstring strength testing at 60 and 180 deg/s. Between-group analysis was performed using analysis of variance, with an alpha of .05. Results: A total of 98 participants were included in the analysis (31 no block, 36 FNB, and 31 ACB). The mean ± SD age of the patients was 15.26 ± 1.15, 15.50 ± 1.42, and 15.71 ± 1.44, for no block, FNB, and ACB, respectively. At 5.61 months postoperatively, there was no significant difference across the 3 groups in isokinetic quadriceps deficits ( P ≥ .99), and the only significant difference in isokinetic hamstring deficit was observed for peak flexion at 180 deg/s, in which the ACB group had lower peak torque than the FNB group (–9.80% ± 3.48% vs 2.37% ± 3.23%; P = .035). The ratio of participants with a deficit exceeding 15% did not differ significantly among the 3 groups. Conclusion: Contrary to previous research, our findings indicate only minimal difference in quadriceps strength among the 3 types of perioperative analgesia in adolescents approximately 6 months after ACL reconstruction. The only significant strength deficit was seen in the hamstrings of patients receiving ACB at peak flexion as compared with those receiving FNB.

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Review of Outcomes in Pediatric Patients Undergoing Anterior Cruciate Ligament Repairs With Regional Nerve Blocks

Cited by 4 publications

References 18 publications

Overprescribing and Undereducating: a Survey of Pre- and Postoperative Pain Protocols for Pediatric Anterior Cruciate Ligament Surgery

Overprescribing and Undereducating: a Survey of Pre- and Postoperative Pain Protocols for Pediatric Anterior Cruciate Ligament Surgery

The Utilization of Regional Anesthesia Among Pediatric Patients: A Retrospective Study

Quadriceps and Hamstring Strength in Adolescents 6 Months After ACL Reconstruction With Femoral Nerve Block, Adductor Canal Block, or No Nerve Block

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